Fungal pathogens pose a major threat to public health as they are becoming increasingly common and resistant to treatment with only four classes of antifungal drugs currently available and few candidates in the clinical pipeline. Most fungal pathogens lack rapid and sensitive diagnostics, and existing ones are not widely available or affordable globally. THE DOCUMENT.
26 OCT –
WHO has published a report containing the first ever list of fungal “priority pathogens”, a catalog of the 19 fungi that pose the greatest threat to public health.
The WHO List of Priority Pathogens for Fungi (FPPL) is the first global effort to systematically prioritize fungal pathogens, considering unmet research and development (R&D) needs and perceived importance to public health . WHO FPPL aims to focus and guide further research and policy interventions to strengthen the global response to fungal infections and antifungal resistance.
Fungal pathogens pose a major threat to public health as they are becoming increasingly common and resistant to treatment with only four classes of antifungal drugs currently available and few candidates in the clinical pipeline. Most fungal pathogens lack rapid and sensitive diagnostics, and existing ones are not widely available or affordable globally.
Invasive forms of these fungal infections often affect seriously ill patients and those with significant conditions related to the underlying immune system. Populations at greatest risk for invasive fungal infections include those with cancer, HIV / AIDS, organ transplants, chronic respiratory disease, and post-primary TB infection.
Emerging evidence indicates that the incidence and geographic range of fungal diseases are expanding around the world due to global warming and increased travel and international trade. During the COVID-19 pandemic, the reported incidence of invasive fungal infections increased significantly among hospitalized patients. As fungi that cause common infections (such as oral candida and vaginal thrush) become more resistant to treatment, the risks for developing more invasive forms of infections in the general population also grow.
“Emerging from the shadow of the antimicrobial bacterial resistance pandemic, fungal infections are growing and increasingly resistant to treatments, becoming a public health problem around the world,” said Dr. Hanan BalkhyWHO Deputy Director-General for Antimicrobial Resistance (AMR).
Despite growing concern, fungal infections receive very little attention and resources, leading to a paucity of quality data on fungal disease distribution and antifungal resistance patterns. As a result, the exact burden of fungal disease and antifungal resistance is unknown and the response is thus undermined.
Three priority categories
The WHO FPPL list is divided into three categories: critical, high and medium priority. The fungal pathogens of each priority category are thus classified mainly due to their impact on public health and / or the emerging risk of antifungal resistance. While recognizing these critical pathogens as a public health concern globally, WHO stresses that FPPL must be interpreted and contextualized carefully, as some endemic pathogens may be of more concern in their respective regional or local contexts.
Need for more evidence and priority areas for action
The report’s authors stress the need for more evidence to inform the response to this growing threat and to better understand the burden, both of the disease and of antifungal resistance. The report also stresses the urgent need for coordinated action to address the impact of antifungal use on resistance across the One Health spectrum and calls for expanding equal access to quality diagnostics and treatments.
“We need more data and evidence on fungal infections and antifungal resistance to inform and improve the response to these priority fungal pathogens,” said Dr. Haileyesus GetahunDirector of WHO, Department of Global Coordination of AMR.
The FPPL report highlights strategies for policy makers, public health professionals and other stakeholders. The strategies proposed in the report collectively aim to generate evidence and improve the response to these priority fungal pathogens, including preventing the development of resistance to antifungal drugs. The main recommended actions are focused on: (1) strengthening the capacity and oversight of the laboratory; (2) supporting investment in research, development and innovation; and (3) enhance public health interventions for prevention and control.
“Countries are encouraged to take a step by step approach, starting with strengthening their fungal disease laboratory and surveillance capabilities and ensuring equal access to existing quality therapies and diagnostics, globally,” Getahun added.
Resistance to antifungal drugs is partly driven by inappropriate antifungal use across the One Health spectrum. For example, reckless use of antifungals in agriculture has been linked to increased rates of azole-resistant Aspergillus fumigatus infections. The report also calls for WHO’s collaborative effort with quadripartite organizations and other partners to address the impact of antifungal use on resistance across the One Health spectrum.
October 26, 2022
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